https://www.cidrap.umn.edu/news-perspective/2022/09/stewardship-resistance-scan-sep-30-2022
Stewardship / Resistance Scan for Sep 30, 2022
Carbapenem-resistant Klebsiella transmission;
Inappropriate antibiotics in South Africa
Filed Under:
Antimicrobial Stewardship
Wide healthcare transmission of carbapenem-resistant Klebsiella noted
A multicenter US study identified widespread nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within and between healthcare settings, researchers reported yesterday in Clinical Infectious Diseases.
Using data from patients enrolled in the prospective Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales (CRACKLE-2) study, which includes patients with at least one clinical culture of carbapenem-resistant Enterobacterales (CRE), a team of US researchers created a cohort of patients with clonal group (CG) 258 CRKP who had been enrolled from April 2016 through August 2017.
To better understand CRKP transmission, they used whole-genome sequencing and phylogenetic analysis to evaluate static (defined by genetically related isolates with a most recent common ancestor) and dynamic (incorporating genetic distance, spatial distance, and transmission events) CRKP clusters within and between healthcare systems.
Most patients were admitted from home (150, 43%) or a long-term care facility (115, 33%). In total, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. About half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intra-system and 22 (40%) inter-system clusters. Dynamic clusters consisted of 32 (68%) intra-system and 15 (32%) inter-system clusters and had fewer single nucleotide polymorphism (SNP) differences compared to static clusters (8 vs 9). Dynamic inter-system clusters contained more patients than dynamic intra-system clusters (median, 4 vs 2).
"Most patients had a CRKp isolate that could be genetically linked to an isolate of at least one other patient, regardless of the method used to assign clusters," the study authors wrote. "Most patients were part of clusters with patients from the same healthcare system, but about a third of clusters showed evidence of transmission across healthcare systems."
The authors say these observations "emphasize that successful control of multidrug-resistant organisms requires infection prevention measures at both local and regional levels."
Sep 29 Clin Infect Dis abstract
Inappropriate antibiotics common in private practice in South Africa
Analysis of health insurance data found a high rate of inappropriate antibiotic prescribing by private-sector general practitioners (GPs) in South Africa, researchers reported today in JAC-Antimicrobial Resistance.
The analysis of February 2018 prescribing data from the claims database of a private health insurer by researchers from the University of Kwa-Zulu, Natal categorized antibiotic prescriptions as "appropriate," "potentially appropriate," and "inappropriate" based on International Classification of Disease (ICD-10) codes. Further assessments of antibiotic choice, dosage, and duration of treatment were carried out to determine the appropriateness of prescriptions in comparison with treatment guidelines.
A total of 188,141 antibiotics were prescribed for 174,889 patients who consulted private-sector GPs in February 2018. Penicillins were the most frequently prescribed antibiotic class, accounting for 40.7% of all prescriptions, and amoxicillin-clavulanic acid was the most frequently prescribed antibiotic, making up 28.6% of all antibiotics prescribed—even though it was rarely recommended in guidelines. Respiratory diseases generated the most prescriptions, accounting for 46.1% of all diagnoses.
Of all prescriptions, 8.8% were appropriate, 32% were potentially appropriate, 45.4% were inappropriate, and 13.8% could not be assessed. Of those prescriptions deemed appropriate and potentially appropriate, 30.8% were the correct antibiotic, and of the correctly selected antibiotics, 57.7% had correct doses. Of the antibiotics with correct doses, 76.7% had correct dosage frequencies and durations of treatment.
"This is of concern, as under-dosing and over-dosing, even when the antibiotic choices are correct, puts patients at risk of treatment failure and at risk of developing adverse effects, respectively," the study authors wrote.
They concluded, "This study revealed that a substantial number of antibiotics are inappropriately prescribed by GPs in the private primary healthcare sector in South Africa, necessitating urgent stewardship interventions to sustain the efficacy of existing antibiotics, contain antibiotic resistance, improve the standard of care and reduce unnecessary healthcare expenditure by health insurers."
Sep 30 JAC-Antimicrob Resist study
Stewardship / Resistance Scan for Sep 30, 2022
Carbapenem-resistant Klebsiella transmission;
Inappropriate antibiotics in South Africa
Filed Under:
Antimicrobial Stewardship
Wide healthcare transmission of carbapenem-resistant Klebsiella noted
A multicenter US study identified widespread nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within and between healthcare settings, researchers reported yesterday in Clinical Infectious Diseases.
Using data from patients enrolled in the prospective Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales (CRACKLE-2) study, which includes patients with at least one clinical culture of carbapenem-resistant Enterobacterales (CRE), a team of US researchers created a cohort of patients with clonal group (CG) 258 CRKP who had been enrolled from April 2016 through August 2017.
To better understand CRKP transmission, they used whole-genome sequencing and phylogenetic analysis to evaluate static (defined by genetically related isolates with a most recent common ancestor) and dynamic (incorporating genetic distance, spatial distance, and transmission events) CRKP clusters within and between healthcare systems.
Most patients were admitted from home (150, 43%) or a long-term care facility (115, 33%). In total, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. About half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intra-system and 22 (40%) inter-system clusters. Dynamic clusters consisted of 32 (68%) intra-system and 15 (32%) inter-system clusters and had fewer single nucleotide polymorphism (SNP) differences compared to static clusters (8 vs 9). Dynamic inter-system clusters contained more patients than dynamic intra-system clusters (median, 4 vs 2).
"Most patients had a CRKp isolate that could be genetically linked to an isolate of at least one other patient, regardless of the method used to assign clusters," the study authors wrote. "Most patients were part of clusters with patients from the same healthcare system, but about a third of clusters showed evidence of transmission across healthcare systems."
The authors say these observations "emphasize that successful control of multidrug-resistant organisms requires infection prevention measures at both local and regional levels."
Sep 29 Clin Infect Dis abstract
Inappropriate antibiotics common in private practice in South Africa
Analysis of health insurance data found a high rate of inappropriate antibiotic prescribing by private-sector general practitioners (GPs) in South Africa, researchers reported today in JAC-Antimicrobial Resistance.
The analysis of February 2018 prescribing data from the claims database of a private health insurer by researchers from the University of Kwa-Zulu, Natal categorized antibiotic prescriptions as "appropriate," "potentially appropriate," and "inappropriate" based on International Classification of Disease (ICD-10) codes. Further assessments of antibiotic choice, dosage, and duration of treatment were carried out to determine the appropriateness of prescriptions in comparison with treatment guidelines.
A total of 188,141 antibiotics were prescribed for 174,889 patients who consulted private-sector GPs in February 2018. Penicillins were the most frequently prescribed antibiotic class, accounting for 40.7% of all prescriptions, and amoxicillin-clavulanic acid was the most frequently prescribed antibiotic, making up 28.6% of all antibiotics prescribed—even though it was rarely recommended in guidelines. Respiratory diseases generated the most prescriptions, accounting for 46.1% of all diagnoses.
Of all prescriptions, 8.8% were appropriate, 32% were potentially appropriate, 45.4% were inappropriate, and 13.8% could not be assessed. Of those prescriptions deemed appropriate and potentially appropriate, 30.8% were the correct antibiotic, and of the correctly selected antibiotics, 57.7% had correct doses. Of the antibiotics with correct doses, 76.7% had correct dosage frequencies and durations of treatment.
"This is of concern, as under-dosing and over-dosing, even when the antibiotic choices are correct, puts patients at risk of treatment failure and at risk of developing adverse effects, respectively," the study authors wrote.
They concluded, "This study revealed that a substantial number of antibiotics are inappropriately prescribed by GPs in the private primary healthcare sector in South Africa, necessitating urgent stewardship interventions to sustain the efficacy of existing antibiotics, contain antibiotic resistance, improve the standard of care and reduce unnecessary healthcare expenditure by health insurers."
Sep 30 JAC-Antimicrob Resist study